Is attention deficit hyperactivity disorder (ADHD) overdiagnosed and overtreated?

In the public coverage of ADHD, there is a widespread belief that doctors overdiagnose and overtreat the disorder, particularly in children with behavioral issues.

A large study published in 2021 found indications of ADHD overdiagnosis, with the authors emphasizing that people with other diseases may be diagnosed with ADHD instead. According to other evidence, children who are among the youngest in their class are more likely to be diagnosed with ADHD. Their immaturity and resulting behavioral issues may appear to be indications of ADHD when, in reality, they are caused by their age.

Personal experience and bias may influence a person’s perspective on ADHD overdiagnosis. People who oppose psychiatry are working hard to disprove the existence of ADHD. ADHD advocates, on the other hand, may push for earlier and more frequent diagnosis.

The issue of ADHD overdiagnosis is controversial, and it’s difficult to quantify. What is apparent, however, is that ADHD is frequently undiagnosed or misdiagnosed. About three out of every four children with ADHD receive therapy, but only 32% receive the pharmaceutical and behavioral treatment combination that most experts, including the American Academy of Pediatrics, recommend.

The risk of ADHD overdiagnosis and misdiagnosis can be reduced by seeking care from a skilled physician, utilizing specified diagnostic criteria, and ruling out other possible diagnoses. Continue reading to find out more.

Is ADHD overdiagnosed? 

adhd in children

According to emerging data, ADHD may be overdiagnosed. The percentage of children aged 3–17 years who have been diagnosed with ADHD has increased over time, from 5.5 percent in 1997 to 9.8 percent in 2018. This rise does not always imply a crisis of overdiagnosis. Other evidence, on the other hand, suggests that overdiagnosis is a factor in this trend.

In an older child, age-appropriate actions could be indications of ADHD. A 3-year-old, for example, cannot concentrate on schooling that a 6-year-old can do. According to some studies, this relative immaturity may play a role in overdiagnosis.

The youngest third of students in a classroom were more likely to take stimulant ADHD medicines than the oldest third, according to a 2016 study of children attending school in Israel.

Because a few months can make a significant difference in a child’s skills and maturity, it’s likely that some youngsters are prescribed ADHD medication due to comparative immaturity rather than ADHD.

A thorough review published in 2021 gives credence to the idea that doctors overdiagnose ADHD. The researchers looked through 334 studies and discovered the following:

  • The number of ADHD diagnoses has increased.
  • The treatment of ADHD with medication has increased.
  • The increase in ADHD may be due in part to diagnosing people who have only mild ADHD.

Furthermore, the five studies that looked at the risks and benefits of treatment revealed that the harms of treatment may outweigh the benefits in milder cases of ADHD.

Why?

Although some studies suggest that ADHD is overdiagnosed, there is no definitive study to explain why. The following are some possible explanations:

  • ADHD can be diagnosed in children who are younger than their grade-level peers and so less developmentally advanced.
  • When a person has another condition, they may be misdiagnosed. Sensory processing disorders, for example, can have symptoms that are similar to ADHD.
  • Ineffective parenting practices could be a contributing factor. Ineffective parenting may contribute to behavioral difficulties in children with ADHD, according to a 2015 study. While this isn’t a contributing reason to overdiagnosis, it could explain an apparent rise in ADHD-related behavioral issues. The researchers discovered a link between the use of punishment and inattention symptoms. Negligent parenting was also linked to ADHD symptoms.
  • It’s also worth noting that increased awareness is an important component. Parents, caregivers, and healthcare professionals may be more aware of inattentive signs as a result of increased ADHD awareness. As a result, more people with moderate symptoms can be diagnosed with ADHD.

Overdiagnosing ADHD

The right treatment for ADHD can make a difference in people’s lives, but too much treatment can be damaging. There are side effects to every treatment. The following are some of the possible adverse effects:

  • growth delays
  • anxiety
  • rapid heart rate
  • high blood pressure
  • loss of appetite
  • trouble sleeping

The stigmatization of developmentally normal behaviors may result from diagnosing ADHD based on immaturity. It may also lead a person and their parents or caregivers to be concerned about the long-term consequences of an inaccurate diagnosis.

Overtreatment problems

While evidence supports the concept of overdiagnosis, research on overtreatment shows the reverse.

Although it is true that some people without ADHD receive therapy as a result of overdiagnosis, people with ADHD are generally undertreated.

The majority of treatment guidelines emphasize the importance of both medication and behavioral and lifestyle changes. The American Academy of Pediatrics, for example, recommends that children with ADHD above the age of 6 get medication as well as behavioral interventions such as classroom help and therapy.

Children under the age of six, on the other hand, should only be given medication if all other options have failed. According to the Centers for Disease Control and Prevention (CDC), most children with ADHD do not receive treatment that meets these standards, according to a 2016 parent survey. The findings revealed that:

  • About 23% of children with ADHD received no treatment.
  • About 30% received only medication.
  • About 15% received behavioral treatments.
  • About 32% received both medication and behavioral interventions.

Avoiding overdiagnosis and overtreatment

Some of the options for preventing overdiagnosis include:

  • Using scientifically validated rating scales to diagnose ADHD: The Conners’ Rating Scales, the Vanderbilt ADHD Parent Rating Scale, and the Child Behavior Checklist are among these scales. Using these diagnostic methods instead of depending on first impressions or subjective assessments could be more effective.
  • Considering other diagnoses: ADHD isn’t the only cause of hyperactivity and inattention. These symptoms can also be caused by a variety of other disorders, such as sensory processing disorder and autism.
  • Assessing for symptom consistency: A period of inattention in a new environment or hyperactivity that only occurs in one or two settings may not indicate ADHD. Instead, these behaviors may indicate an issue with the environment, such as poor parenting or a stressful school setting.
  • Considering how maturity might affect diagnosis: A child who behaves differently than the rest of his or her classmates does not necessarily have ADHD, especially if they are several months younger than the majority of their classmates.
  • Assessing how well treatment works: Parents and healthcare providers should monitor the treatment’s effects to see if it improves the child’s behavior and provides assistance. Adults with ADHD should consider whether taking medication improves their performance significantly.

The majority of people concerned about ADHD overdiagnosis are concerned about medication usage. If a person just has minor ADHD symptoms, it may be best to attempt behavioral therapies first and then medication if those techniques fail.

The behavioral tactics for dealing with ADHD are similar to those used by parents or caregivers to deal with behavioral issues in children who do not have ADHD. These therapies have not been shown to be hazardous.

Conclusion

ADHD can be both underdiagnosed and overdiagnosed, and it can also be both undertreated and overtreated.

According to the research, some people who do not require therapy still receive it, while many people who do require treatment receive insufficient care.

It’s also possible that some children obtain an excessive amount of ADHD diagnoses, while others receive none at all. Individual definitions of overdiagnosis and overtreatment differ, hence the statistics aren’t conclusive.

ADHD is a real diagnosis, and people with it require therapy. These facts call into question the most outspoken opponents of ADHD therapy. Nonetheless, it is obvious that some people who take ADHD medication may not require it and may possibly be less healthy as a result of its use.

Sources

  • https://www.cdc.gov/ncbddd/adhd/timeline.html
  • https://chadd.org/for-professionals/clinical-practice-tools/
  • https://www.cdc.gov/ncbddd/adhd/data.html
  • https://www.medicalnewstoday.com/articles/is-adhd-overdiagnosed-and-overtreated
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4443828/
  • https://onlinelibrary.wiley.com/doi/abs/10.1002/pds.3962
  • https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2778451
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4710942/
  • https://www.cdc.gov/ncbddd/adhd/treatment.html